Analyze the context of recommendations (1)

Context matters

We have seen in other modules that context matters when it comes to understanding issues, gather and analyzing data, and using the core concepts of sex, gender, diversity and equity. Context is also important for the development and implementation of recommendations.

Let’s compare the issue of tobacco control, which we’ve looked at in some detail already, with responses to the HIV/AIDS epidemic. As we have seen, initial approaches to tobacco control tended to be fairly generic, treating all smokers as the same and therefore needing the same interventions. These policies were “gender-blind”. Fortunately, researchers using sex and gender-based analysis began to draw attention to the differing realities and needs of women and men, boys and girls in diverse settings. Women and men may smoke for different reasons, have different experiences of addiction, and be affected differently by relationships and gender expectations. Women and men in different societies may use tobacco differently or have a different economic relationship to it. As a result of these insights, tobacco control efforts have begun to shift away from a universal approach to one that is more “gender-responsive”. According to a 2007 report from the World Health Organization, “It is … important that tobacco control policies recognize and take into account gender norms, differences and responses to tobacco, in order to counteract these pressures, reduce tobacco use and improve the health of men and women worldwide” (WHO 2007, p.1). This is a critical step in the evolution towards transformative policies.

Policy and program responses to HIV/AIDS have followed a different path. Initially, HIV control efforts were completely targeted – rather than universal – because HIV and AIDS-related illnesses were closely identified with a specific sub-population – gay men. Indeed, we might argue that interventions at this stage were “gender-imposed” because they reinforced stigma and discrimination by blaming the spread of HIV on sexual orientation. As the virus spread to other populations and sub-populations, governments in many countries continued to target high-risk groups, such as injection drug users and people with health conditions requiring blood transfusion. This approach, like tobacco control policies, was “gender-blind”. Gradually, interventions became more “gender-aware” as research made it starkly obvious that women and girls were among those at greatest risk of HIV infection. With this realization, HIV strategies began to shift to become more “gender-responsive”, including research on female-specific prevention strategies, such as the female condom and microbicides.

Interestingly, however, the evolution of HIV policies and programs has been complicated by international recommendations. In countries where HIV is widespread, the United Nations has advised the adoption of universal policies and programs, “designed to reach all segments of society.” But in countries where infection rates are low or seemingly concentrated in specific sub-populations, a targeted approach was recommended, “prioritizing HIV prevention among those at highest risk.” On the surface, this would appear to be an approach that is “gender-responsive” because it would lead to the development of programs tailored to the needs of women and girls. As the Public Health Agency of Canada argued, a “population-specific approach results in evidence-based, culturally appropriate responses that are better able to address the realities that contribute to infection and poor health outcomes for the target groups” (PHAC, 2007). But this approach to HIV control ignores the fact that women and girls are not a sub-population, but rather the majority of the population in Canada. Moreover, women and girls are found in almost every other “at risk” group identified in Canadian HIV/AIDS policies. Interventions that focus on specific groups may ignore the intersection of sex, gender and diversity, and in the case of HIV, may also neglect groups who are not currently vulnerable to HIV infection, but may become so in the future. In the earliest days of the pandemic, no one suspected that women and girls might be at risk of HIV infection and as a result no efforts were made to protect them. More than half of those living with HIV today are women and girls. An SGBA of HIV/AIDS strategies doesn’t lead us towards a “targeted” or “tailored” approach, as the study of tobacco control policies has done. It suggests that transformative policies for HIV/AIDS would be generalized because the pandemic is everyone’s concern and because gender affects everyone. [1]

These two examples serve to remind us that engaging in SGBA is not like following the same recipe to make the same cake every time. We can’t know ahead of time what the conclusion or recommendations will be because they emerge from an iterative process. At the same time, the insights and recommendations arising from an SGBA are specific to a particular context, reflecting the particular features of an issue, the population under consideration, the evidence available to us, and the history of analysis and action.

Source: [1] UNAIDS. (2005). Intensifying HIV prevention: UNAIDS policy position paper. Geneva; Public Health Agency of Canada (2007). Populations at risk: Why focus on key populations?

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